title: Elective induction of labor at term compared with expectant management: maternal and neonatal outcomes.
abstract: OBJECTIVE
  To test the association of elective induction of labor at term compared with expectant management and maternal and neonatal outcomes.
  
  
  METHODS
  This was a retrospective cohort study of all deliveries without prior cesarean delivery in California in 2006 using linked hospital discharge and vital statistics data. We compared elective induction at each term gestational age (37-40 weeks) as defined by The Joint Commission with expectant management in vertex, nonanomalous, singleton deliveries. We used multivariable logistic regression to test the association of elective induction and cesarean delivery, operative vaginal delivery, maternal third- or fourth-degree lacerations, perinatal death, neonatal intensive care unit admission, respiratory distress, shoulder dystocia, hyperbilirubinemia, and macrosomia (birth weight greater than 4,000 g) at each gestational week, stratified by parity.
  
  
  RESULTS
  The cesarean delivery rate was 16%, perinatal mortality was 0.2%, and neonatal intensive care unit admission was 6.2% (N=362,154). The odds of cesarean delivery were lower among women with elective induction compared with expectant management across all gestational ages and parity (37 weeks [odds ratio (OR) 0.44, 95% confidence interval (CI) 0.34-0.57], 38 weeks [OR 0.43, 95% CI 0.38-0.50], 39 weeks [OR 0.46, 95% CI 0.41-0.52], 40 weeks [OR 0.57, CI 0.50-0.65]). Elective induction was not associated with increased odds of severe lacerations, operative vaginal delivery, perinatal death, neonatal intensive care unit admission, respiratory distress, shoulder dystocia, or macrosomia at any term gestational age. Elective induction was associated with increased odds of hyperbilirubinemia at 37 and 38 weeks of gestation and shoulder dystocia at 39 weeks of gestation.
  
  
  CONCLUSIONS
  Elective induction of labor is associated with decreased odds of cesarean delivery when compared with expectant management.
  
  
  METHODS
  : II.
authors.affiliation: Oregon Health & Science University, Portland, Oregon; the University of California, San Francisco, San Francisco, California; Penn State University College of Medicine, Hershey, Pennsylvania; Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; the Group Health Research Institute, Seattle, Washington; and Kaiser Permanente Southern California, Pasadena, California.
authors.forename: Blair G
authors.initials: BG
authors.lastname: Darney
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Snowden
authors.forename: Yvonne W
authors.initials: YW
authors.lastname: Cheng
authors.forename: Lorie
authors.initials: L
authors.lastname: Jacob
authors.forename: James M
authors.initials: JM
authors.lastname: Nicholson
authors.forename: Anjali
authors.initials: A
authors.lastname: Kaimal
authors.forename: Sascha
authors.initials: S
authors.lastname: Dublin
authors.forename: Darios
authors.initials: D
authors.lastname: Getahun
authors.forename: Aaron B
authors.initials: AB
authors.lastname: Caughey
mesh_terms: D002140:California / Q000453:epidemiology; D002585:Cesarean Section / Q000706:statistics & numerical data*; D017558:Elective Surgical Procedures / Q000009:adverse effects* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology*; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data; D007751:Labor, Induced / Q000009:adverse effects* / Q000706:statistics & numerical data; D016015:Logistic Models; D054238:Perinatal Mortality; D010502:Perineum / Q000293:injuries; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D012189:Retrospective Studies; D047929:Term Birth